Provider Demographics
NPI:1396212015
Name:CASTRO-JIMENEZ, MARIA LOLA (AGPCNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LOLA
Last Name:CASTRO-JIMENEZ
Suffix:
Gender:F
Credentials:AGPCNP-BC
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Mailing Address - Street 1:42 NICHOLS ST STE 10
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2196
Mailing Address - Country:US
Mailing Address - Phone:585-637-7558
Mailing Address - Fax:585-637-7566
Practice Address - Street 1:42 NICHOLS ST STE 10
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-2196
Practice Address - Country:US
Practice Address - Phone:585-637-7558
Practice Address - Fax:585-637-7566
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2023-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY308783363LA2200X
NYF308783-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health